Provider Demographics
NPI:1346368412
Name:EYE CARE AND COSMETIC CENTER, LLC
Entity Type:Organization
Organization Name:EYE CARE AND COSMETIC CENTER, LLC
Other - Org Name:REGIONAL EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-654-1061
Mailing Address - Street 1:2421 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2710
Mailing Address - Country:US
Mailing Address - Phone:225-654-1061
Mailing Address - Fax:225-654-0791
Practice Address - Street 1:2421 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2710
Practice Address - Country:US
Practice Address - Phone:225-654-1061
Practice Address - Fax:225-654-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty